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Background: Understanding current substance use practices is critical to reduce and prevent overdose deaths among individuals at increased risk including persons who use and inject drugs. Because individuals participating in harm reduction and syringe service programs are actively using drugs and vary in treatment participation, information on their current drug use and preferred drugs provides a unique window into the drug use ecology of communities that can inform future intervention services and treatment provision., Methods: Between March and June 2023, 150 participants in a harm reduction program in Burlington, Vermont completed a survey examining sociodemographics; treatment and medication for opioid use disorder (MOUD) status; substance use; injection information; overdose information; and mental health, medical, and health information. Descriptive analyses assessed overall findings. Comparisons between primary drug subgroups (stimulants, opioids, stimulants-opioids) of past-three-month drug use and treatment participation were analyzed using chi-square and Fisher's exact test., Results: Most participants reported being unhoused or unstable housing (80.7%) and unemployed (64.0%) or on disability (21.3%). The drug with the greatest proportion of participants reporting past three-month use was crack cocaine (83.3%). Fentanyl use was reported by 69.3% of participants and xylazine by 38.0% of participants. High rates of stimulant use were reported across all participants independent of whether stimulants were a participant's primary drug. Fentanyl, heroin, and xylazine use was less common in the stimulants subgroup compared to opioid-containing subgroups (p < .001). Current- and past-year MOUD treatment was reported by 58.0% and 77.3% of participants. Emergency rooms were the most common past-year medical treatment location (48.7%; M = 2.72 visits)., Conclusions: Findings indicate high rates of polysubstance use and the underrecognized effects of stimulant use among people who use drugs-including its notable and increasing role in drug-overdose deaths. Crack cocaine was the most used stimulant, a geographical difference from much of the US where methamphetamine is most common. With the increasing prevalence of fentanyl-adulterated stimulants and differences in opioid use observed between subgroups, these findings highlight the importance and necessity of harm reduction interventions (e.g., drug checking services, fentanyl test strips) and effective treatment for individuals using stimulants alongside MOUD treatment., (© 2024. The Author(s).)

Introduction: Population studies highlight that alcohol and marijuana use are correlated with cigarette smoking and other tobacco use. The aim of our study was to describe the ways in which alcohol and drug use may affect cigarette smoking and cessation in socioeconomically-disadvantaged young adult (SDYA) smokers., Methods: Thirty-six SDYA smokers aged 18-29 participated in eight focus groups and two individual interviews in Burlington, Vermont in 2018. Structured focus groups addressed poly-tobacco use, other substance use and co-use with tobacco, and the contexts and facilitators that cue SDYA smoking. Participants were also asked their reasons for smoking, barriers to cessation, and messages or modalities that would make smoking cessation more novel or relevant. Three coders implemented the Framework Method to systematically code focus group transcripts., Results: In this sample of SDYA smokers, four key themes emerged around the relationships between alcohol and drug use and smoking: 1) frequent co-use of tobacco and other substances, 2) changes in frequency of smoking when using other substances, including chain smoking when drinking and substituting cigarettes with marijuana, 3) cigarettes as a last remaining addiction for those in recovery from other substance use and, 4) fears that quitting smoking would cause relapse to other substances., Discussion: Co-use of other substances emerged as a reason for smoking and a barrier to quitting, including a concern that quitting smoking would trigger drug or alcohol relapse. Findings support demand for interventions that address substance co-use to improve smoking cessation in SDYA smokers., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Smoking during pregnancy is the leading preventable cause of poor pregnancy outcomes in the United States. In population studies and nationwide surveys, pregnant smokers report more illicit drug use than pregnant nonsmokers. The purpose of this study was to examine the prevalence of illicit drug use among pregnant women enrolled in clinical trials for smoking cessation., Methods: Urine specimens from 115 pregnant women were tested for illicit drug use during a study intake visit (~10th week of pregnancy) and during the final antepartum (FAP) smoking-status assessment (~28th week of pregnancy). Participants smoked about 18 cigarettes/day prepregnancy, were generally young (<25 years), Caucasian, with a high school education and without private insurance., Results: About 34% of specimens from the intake visit and 25% of those from the FAP assessment tested positive for an illicit drug. The most common drug detected was marijuana (90% of positive specimens), followed by opioids (18%), cocaine (5%), benzodiazepines (3%), and methadone (3%). None tested positive for amphetamines. The majority of women (53%) who tested positive for an illicit substance at intake also tested positive at the FAP assessment., Conclusions: Approximately a quarter to a third of pregnant women enrolled in these smoking-cessation trials were determined to be using illicit drugs, with marijuana use being the most prevalent. Those providing smoking-cessation services to pregnant women may want to be prepared to assist with obtaining services for other drug use as well.

The present study was conducted to examine several different methods and cutpoints for determining smoking status in pregnant and recently postpartum women. Self-reported smoking status, urine cotinine levels determined by gas chromatography (GC) and by enzyme immunoassay testing (EMIT), and breath carbon monoxide (CO) levels were assessed at 28 weeks antepartum and 12 and 24 weeks postpartum in 131 women enrolled in studies on smoking cessation and relapse prevention. Classifications based on urine-cotinine GC testing served as the standard in most analyses. Overall agreement between self-reported smoking status and classification based on urine-cotinine GC testing was excellent (> or =95%) at several cutpoints (50, 25, and 12.5 ng/ml) but highest at 25 ng/ml. Classifications based on EMIT urine cotinine levels were in nearly perfect (> or =98%) agreement with those made by GC when the cutpoint for the former was set at approximately 80 ng/ml (79-87 ng/ml). Classifications based on breath CO were in relatively poor agreement (< or =87%) with GC classifications at all cutpoints examined but best at 4 ppm. Overall, these results provide detailed information on several commonly used methods for classifying smoking in pregnant and recently postpartum women that should be practically useful to researchers and clinicians involved in efforts to eliminate smoking in this population.

Higher rates of delay discounting have been consistently noted in substance abusers compared to non-drug-using matched controls. Additional data from some studies comparing discounting rates in current versus former substance abusers suggest that discounting rates may be adaptable and that drug abstinence may be associated with reductions in discounting. The primary purpose of the present study was to determine whether a period of cocaine abstinence (at least 30 days) resulted in altered discounting rates of money in a population of primary cocaine-dependent patients compared to current cocaine users and non-drug-using matched controls. Results suggest that there was no difference in discounting between currently abstinent and currently using cocaine-dependent outpatients. When these two groups were combined, cocaine-dependent patients showed higher discounting rates than non-drug-using matched controls. These data replicate previous work in cocaine-dependent and other substance abusers compared to non-drug-using controls and suggest that a longer period of abstinence may be required to modify discounting in this population.

Alcohol use and associated factors were studied in 124 consecutive cocaine-dependent admissions to an outpatient substance abuse clinic. Two analyses were conducted: First, those who did and did not meet criteria for current alcohol dependence were compared on sociodemographic and drug use characteristics. Second, patients who reported simultaneous cocaine and alcohol use on > 50% vs. < or = 50% of the occasions that they used cocaine were compared using the same dependent measures. Fifty-seven percent of patients met criteria for current alcohol dependence. Those with and without alcohol dependence did not differ on any sociodemographic characteristics, but those with dependence scored higher on the alcohol and family subscales of the Addiction Severity Index, the Michigan Alcoholism Screening Test, and measures of alcohol use, and were more likely to use cocaine and alcohol simultaneously, to use cocaine with friends and in social settings, and were more likely to report financial difficulties and unwanted sexual relations as adverse consequences of their cocaine use. Sixty-four percent of patients reported > 50% simultaneous cocaine and alcohol use. The two groups did not differ on any sociodemographic characteristics, but those reporting greater simultaneous use were more likely to be alcoholic, scored higher on most measures of alcohol use, and were more likely to report using cocaine with friends and in social settings. The only other differences observed between the two groups were fewer reports of seizures or difficulty concentrating in the group reporting greater simultaneous use. The present results confirm prior reports on the widespread prevalence of alcohol dependence among cocaine-dependent patients and extend them by providing new information on the prevalence and other characteristics of simultaneous cocaine and alcohol use.

Nicotine and caffeine use in 87 cocaine-dependent persons seeking treatment at an outpatient clinic were compared to use of those substances in a matched general population sample (n = 78). The prevalence of cigarette smoking was significantly greater in the cocaine-dependent sample (75% vs. 22%). Within the cocaine-dependent sample, smokers were younger, less educated, employed in lesser skilled jobs, and reported an earlier onset and more frequent use of cocaine. The prevalence of caffeine use was significantly less in the cocaine-dependent group (68% vs. 83%), although, among caffeine users, the cocaine group drank significantly more caffeinated beverages per day than matched controls (4.9 vs. 3.3). Interestingly, regular caffeine use was associated with less frequent cocaine use within the cocaine-dependent sample. To our knowledge, this study is the first to report on prevalence of smoking and caffeine use among cocaine-dependent individuals, and suggests that use of these other substances may influence the onset and pattern of cocaine use.